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Regular Donations to Haven House
If you wish to support the work of Haven House through regular donations would you please complete the form below and return it to Haven House Treasurer, Dr Jackie Long, c/o Haven House
For your records: Amount __________________________ monthly / quarterly / annually*
*delete as appropriate
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I/we (full name) __________________________________________________________________________________________
of (address) ___________________________________________________________________________________________
instruct (your bank) ________________________Branch _____________________ Sort Code __________________
to transfer from my/our account (account name) ______________________(account number)__________________
the sum of____________________ monthly / quarterly / annually*
commencing on (dd/mm/yyyy)_______________________ until further notice.
To the Account below:-
Account Title: Haven House
Account number: 2196422
Sort Code: 30-98-06
Bank Address: Lloyds TSB, 124 High St., Staple Hill, Bristol BS16 5HJ
Signed: ______________________________________ Date: _____________________________
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I have / have not* signed the Gift Aid Declaration Form.
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